End of life care in UK care homes – controlled drugs: systematic review and narrative synthesis

Abstract

BackgroundControlled drugs (CDs) such as opioids and midazolam are commonly used in end-of-life care symptom management for care home residents.AimTo review the published evidence concerning the prescribing, storage, use and disposal of CDs for end-of-life care for care home residents in the UK.DesignSystematic review and narrative synthesis.MethodsSeven databases (Medline, CINAHL, Embase, PsycINFO, Web of Science, Cochrane Library, and Social Care Online) were searched from January 2000 to January 2021, alongside reference, citation and journal hand searches. Gough’s ‘Weight of Evidence’ framework was used to appraise the relevance of studies to the review questions.ResultsThe search yielded 1279 titles, from which 125 abstracts and then 42 full-text papers were screened. 14 papers were included in the synthesis. Prescribing is primarily by general practitioners, with administration by nurses. Nurses frequently report feeling inadequately trained in the use of CDs. The storage, monitoring and disposal of end-of-life care CDs in UK care homes has not been researched to date. The attitudes and experiences of residents and family members regarding these medications also remain unknown.ConclusionThe current widespread use of CDs for end-of-life care in care homes has a limited evidence base. The lack of research concerning the storing, monitoring and disposing of CDs, alongside the limited evidence concerning resident and family members’ perspectives, is a significant knowledge deficit that requires urgent attention.PROSPERO registration numberCRD42020173014.